We’re already making a difference as a “High-Reliability Organization”

CK CARES Stands for...

Commitment to Safety and Service

Knowledge

Compassion and Empathy

Accountability

Respect and Professionalism

Excellence

Stewardship of Resources

When people share a few essential values — the values that define our culture — they can align their decisions and actions to build better relationships and work together toward our common goals.

Crozer-Keystone Health System is committed to improving the safety, quality, experience and cost of our patients’ care. These are not only the right things to do for our patients and our community but now, health-care governing bodies and payers also measure our performance and provide reimbursement based on this performance.

Over the years, Crozer-Keystone has made great strides in meeting our improvement goals — for example, through our quality and evidence-based medicine initiatives to improve the care of the patients with severe sepsis — but individual initiatives are not enough to achieve continuous improvement across all departments and for all patients we serve. Continuous improvement will take a commitment to essential values from every member of our health system — and the consistent, desired actions that demonstrate those values.

With this in mind, Crozer-Keystone is introducing CK CARES, a set of core values that will serve as the foundation for every person’s and team’s thoughts, decisions and actions. CK CARES quite simply spells out our Commitment to safety and service, Knowledge, Compassion and empathy, Accountability, Respect, Excellence and Stewardship.

Going forward, these values and the specific behaviors that support them will be the new standards of performance that every employee commits to, in writing, as a condition of employment.

“Crozer-Keystone is doing this for one reason: We believe our patients, and community deserves this level of care,” says Joan K. Richards, CEO of Crozer-Keystone Health System, who is a member of the CK CARES Steering Committee.

“Here at Crozer Keystone, CK CARES will provide us the way to incorporate the values and behaviors necessary to improve patient safety and experience of care,” says Chief Operating Officer Patrick Gavin. “We must be committed as a team, working together to this end.”

A team of leaders and facilitators completed a management education program in February, which introduced managers at every level of the health system to these core values and the behaviors and tools that support them. In turn, managers will bring these values, behaviors and tools to every Crozer-Keystone employee.

Already Making a Difference

Although CK CARES is just starting to roll out through the health system, the first value, “Commitment to safety and service” — our top priority — is already making a difference in our nursing units and across departments. Since July 2012, Crozer-Keystone has focused on developing our patient care teams based on high-reliability organization (HRO) principles using proven behaviors and tools adapted from naval aviation and other high-risk, high-performance industries to improve quality, safety and efficiency.

“Over 100,000 deaths occur in U. S. hospitals every year due to adverse events -- that’s one patient death every 5 minutes and 22 seconds,” observes Robert Haffey, MBA, M.S.N., R.N., president of Taylor Hospital and DCMH . “This is why we are committed to becoming an HRO.”

The goal of high reliability is to eliminate preventable harm to patients by “doing the right thing, the right way, every patient, every time.”

A system-wide team developed sets of HRO “behaviors and tools” for leaders and staff/medical staff. “Our best opportunity to eliminate preventable harm is in the behaviors we choose to use and the use of the associated tools that help catch human errors,” says Eric Dobkin, M.D., FACS, FCCM, chief quality officer and vice president, Quality and Patient Safety. “We developed specific behaviors and tools that have been proven to create a true culture of safety and a positive patient experience.”

For example, leaders are expected to commit to “message on mission” using the tools, “start meetings with a safety message,” “link decisions to safety, quality and satisfaction” and “protect those who speak up.” Staff must “pay attention to detail” — meaning do every task mindfully, never automatically — using the self-checking tool, STAR, for “Stop, Think, Act, Review.”

Teams at each hospital began rolling out the HRO leadership tools in July 2012 instituting the “daily check-in” meetings each day, at the same time, at each hospital. Next came the department-based daily safety huddle, rounding to influence (an action or behavior) and recognizing those behaviors by giving 5:1 (positive) feedback.

A transformation team at each site completed the first phase of leadership and staff training — education on the full set of their respective HRO tools — in June 2013. In addition, over 100 staff members have been trained as safety coaches to work with peers in their units. Since that time, the transformation teams and safety coaches have focused on in-depth training on one tool per month with the goal of building HRO knowledge into skills and ingraining skills as habits.

How are we doing as an HRO? Since June 2012, the health system has reduced the rate of preventable serious safety events by 20 percent with a goal of reaching a 40 percent reduction by June 2014.